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FEBRUARY 2013-DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
- 1. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
1
DISPENSING TECHNIQUE-
YOUR KEY TO SUCCESS
By Dr. Subrata K. Banerjea,
GOLD MEDALIST
B.H.M.S. (HONOURS IN NINE SUBJECTS OF CALCUTTA UNIVERSITY)
FELLOW : AKADEMIE HOMOOPATHISCHER DEUTSCHER ZENTRALVEREIN (GERMANY)
HOMOEOPATHIC MEDICAL ASSOCIATION OF THE UNITED KINGDOM (U.K)
DIRECTOR : BENGAL ALLEN MEDICAL INSTITUTE
PRINCIPAL : ALLEN COLLEGE OF HOMOEOPATHY, ESSEX, ENGLAND
“ S A P I E N S ” , 3 8 2 , B A D D O W R O A D , G R E A T B A D D O W,
C H E L M S F O R D , E S S E X C M 2 9 R A , E N G L A N D
T e l & F a x N o . 4 4 ( 0 ) 1 2 4 5 5 0 5 8 5 9
E . M a i l N o . a l l e n c o l l e g e @ b t i n t e r n e t . c o m
W e b s i t e : w w w . h o m o e o p a t h y - c o u r s e . c o m
My Case Taking
The phrase “A case well taken is half cured” is an example of the wisdom passed from
the classical authors. A gem statement.
I always give emphasis on thorough case taking and a classical prescriber should
never compromise in that.
All my patients complete a case taking questionnaire prior to their consultation with
me. Patients then have the opportunity to think and reflect about their symptoms
including the onset and development of symptoms, the chronology, the modalities,
character, the emotional features, their temperament and even their hobbies and
what is important to them.
By having the case taking form in advance, the patient has ample time to ascertain
facts and obtain information from parents or others about their past history and
clarify temperament or reactions. I feel in that way the case becomes thoroughly
complete in presentation for homoeopathic analysis and evaluation.
In India, where the use of homoeopathy is commonplace, I see an enormous number
of patients a day and in order to run an efficient clinic, my assistant discusses the
case with the patient before I see them. The clinicians ask more questions and clarify
the answers on the form, so when the patient enters my consulting room, the case is
well taken before I begin the consultation and assessment.
I give lot of emphasis on cause and aetiology of symptoms. This is an important
starting place from which evaluation and understanding of the developmental history
of the patient can begin, this includes any physical or emotional aetiology. Examples
of considerations are below:
Physical
injury, exposure to damp, cold, any incidences from which you have
never been well since
Emotional
grief, disappointment, stress which can be attributed to the onset of the
current symptoms
Disease
any major illness and you have never been well since
- 2. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
2
Medicinal
use or abuse of conventional and recreational drugs
For ease and accuracy these questions are divided into 10 years life
span, from birth to age 10 years, then 10 years to 20 years and so on.
My Remedy Selection & Dispensing the Dose
Obviously if the case has a clear picture with clear modalities and sensations, I will
take Approach 1, as detailed above.
The constitutional prescribing which has the qualitative totality, not only a mere
quantitative addition of symptoms, the essence, temperament and behaviour of the
patient with the miasmatic totality should be present in the final remedy selection.
I prescribe a single medicine, mostly in centesimal potency which I always dispense in
water. Ref. Organon §288 5th Edition. By dispensing in water I have observed that
aggravation can be avoided and it permits a strong dynamic penetrating action. Ref.
Organon §272 6th edition, §288.
I give one single poppy seed Ref. Foot Note §285 5th edition, globule No.X sized
globule. Ref. Organon Foot Note §246 5th edition and §275 6th edition in some sugar
of milk Ref. § 272 6th edition, to make a medicated sachet. You may note that this
dispensing method is heavily referenced from the Organon of Medicine which is the
source of the classical method. I instruct the patient to dissolve that powder in half a
litre of water which should be shaken and sipped throughout the day, a little should
be saved and topped up with fresh water the next morning and shaken and sipped
throughout the next day. This process should be continued for 5 to 7 days. So one
single globule of medicine, without adding any further dose is to be plussed and
sipped for 5 – 7 days, then no medication for 1 or 2 weeks.
A second dose may not be required if improvement has commenced however if by
chance the recovery has not begun a second dose of the same medicine may be taken
in the same way, in water, over a series of days, diluting as the days proceed.
Each dose of medicine to sip for 7 days
When there is a very good similimum with the totality and characteristic
symptoms in a clear case.
When there are more mental symptoms and a good match with personality
type.
When the patient is quick to act and react
Intellectually keen patients
People with great muscular strength
Lack of reaction to well indicated medicine
Lack of vital reaction lost all susceptibility
Hypersensitive people on allopathic drugs for a long time
In sensitive patients who react unfavourably the medicine can be diluted in
further, in 3 separate glasses of water and using 50ml from the final glass of
dilution in the bottle which will be sipped as described above
- 3. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
3
Each dose medicine to sip for 3--5 days
Sluggish people who are slow to react
Drug dependent cases, on regular allopathic drugs
Terminally ill with gross pathological changes
Rapid fatal diseases
Heavy pathology
Homoeo Prophylaxis
Acute diseases with clear picture
Prescription based on NBWS,to clear up the suppression
Each dose medicine to sip for 1--3 days
Low vitality with high susceptibility those who react powerfully
Acute
Gross structural change, when prescribing 6C for example
By dispensing and instructing the patient as above you are following the “Doctrine of
Minimum Dose”, “Doctrine of Divisibility” and “Doctrine of Plussing” and in my long
experience, I have found the centesimal scale has excellent penetrating dynamic
power and is capable of uprooting deep seated suppressions of the contemporary
world.
LM prescriptions
I do occasionally use the LM scale and was in fact encouraged to do so by a very
famous LM potency prescriber in Calcutta who prescribed only LM scale for over 40
years, whom I observed in practice for several months after my graduation.
Unfortunately, even in this experienced hand I observed aggravation which is meant
to be avoided by using the LM scale. I almost exclusively use the centesimal scale and
I am confident in this scale of potency. Being a strict classical prescriber, I like to
remind you that although Hahnemann mentioned that LM scale is his ‘most perfected’
method I am of the opinion that if Hahnemann had lived 10 more years, he might
have changed his Organon for five more times, Hahnemann was constantly developing
and trying make Homoeopathy perfect.
I earnestly encourage my readers to try the above method of water dispensing, diluting,
plussing and succussing the single dose of centesimal scale and watch your success
with patients grow and flourish.
Advantages of Diluting, Plussing & Dividing the Dose
The medicine gently stimulates the Vital Force and smoothly overpowers the
symptoms
Ref. Hahnemann’s Chronic Disease, P.156 – 157
Avoids aggravation in hypersensitive patients
Diminution of the strong power of medicine Ref.§285 thereby avoiding
aggravation
For best results- Plus and Succuss
By modification of every plussed dose, which is given in several different forms,
it can best extract the morbid disorder Ref. Foot Note §247
Aggravation from Unchanged, Unmodified Dose
By giving an unchanged dose, the vital force revolts §246
- 4. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
4
Divisibility of Dose is not addition of the Dose but gradual proportionate
liberation of energy
Divided dose is the same quantity which is proportionately divided §287 this leads to
a gradual release of energy.
In dosing, think of a pizza, you can finish the whole pizza in one go or you might cut
the same pizza into 20 small pieces and eat 2 in the morning, 2 in the afternoon each
day, thereby dividing your dose of pizza and at the end of the say 5th day you have
finally finished that pizza. Accordingly the patient is having ONE single medicated
globule or pizza, fragmented into smaller doses or slices which gives gentle
stimulation, without appreciable aggravation of the vital force.
If the case is contaminated through drug dependency I will follow Approach 2 as
detailed above and gradually wean off the conventional medicine. Here again I follow
§91 of Organon. Generally I have seen after weaning off 40% - 50% of conventional
medication, the natural disease surfaces. You will see clear modalities, sensations,
character of symptoms and at that stage you follow Approach 1. Do not fire your
polychrest until and unless you prepare the case and match with the totality. MTEK.
Respect your polychrest and do not prescribe a polychrest when there is scarcity of
symptoms such as commonly found in drug dependent cases. By weaning off, when
more symptoms come in the surface, then and only then, fire your polychrest and that
will overpower the disease. So prepare the patient to receive the polychrest.
My Repetition of the Medicine
I do not repeat the medicine very often. As mentioned above, generally I give a single
medicated globule in water, which the patient sips for few days. I might repeat
another dose, if there is no change from the very first dose. The reasoning for giving
the second dose is
Many medicines have primary and secondary action, which Hahnemann
mentioned in Materia Medica Pura in the Bryonia chapter.
In this polluted, hectic environment, smoke, fumes, chemicals, the second dose
will penetrate the vital force, if, per chance the first dose has been antidoted,
lost or spoilt.
Generally after the first prescription, I do a follow-up in 6 – 8 weeks to assess the
reaction to the medicine. I may wait at least 3 – 4 months in chronic cases before
repeating the dose however if there has been even a 2% positive change on any of the
following areas, I will wait and watch with wisdom. WWW. You will never, I repeat
never, gain anything by premature repetition; on the contrary you will always lose.
This is the most difficult part for any homoeopath to learn. I have found over the
years practitioners are enthusiastic and excited, if the patient is 10% better it is too
tempting to repeat the medicine to get a ‘faster’ result this usually means the reverse,
the patient’s improvement will be slower and might even spoil the case.
In order to be exact, during both the initial consultation and follow-up evaluation, I
always ask my patients to evaluate and then grade the main complaints, they might
be one or many. e.g. if the patient is complaining of headache, I will ask to put a grade
about the intensity and severity of the pain out of 10 or a percentage. Similarly I
always ask to put a value out of 10 or a percentage relevant to the following areas
a. General sense of well being
b. Physical Energy, vigour, strength co ordination
c. Mental Energy, power of focus, motivation, concentration and memory
d. Appetite,
e. Sleep, quantity and quality, feels refreshed
- 5. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
5
f. Temperament, emotional tranquility and sense of harmony in the patient
In some cases it is useful for the patient to keep a diary of the changes to their
symptoms and at their appointment can summarise these details.
By adopting this method, during the follow-up consultation when a patient says ‘I am
not feeling any change’ it is possible to compare with the previous report and can
include scrutinizing head to foot symptoms, with the scores of suffering, intensity and
frequency, this will be clear to both the practitioner and patient the exact condition
and you may find in many aspects, patient is 5 to 10% better.
After a successful first prescription, in many cases, I have waited, not prescribed, for
over two years. Of course I do the follow-ups in every 8 weeks or so and I carefully
consider how the patient is responding. In some cases it is beneficial for the patient to
have a prescription of non-medicated globules which is confirmed by many master
Homoeopaths and the medical fraternity alike, including Hahnemann, Organon §91,
§281 6th Edition.
As I said above, even if there is 2% positive change
YOU WAIT & WATCH WITH WISDOM -WWW
Please do not repeat the medicine when there is a positive report, when you will
become proficient at this this you will find yourself amongst the class very successful
prescribers.
The last and final deciding factor is the patient’s sense of well being and emotional
harmony, from the onset of your homoeopathic treatment up until now . This can be
represented in a graph, an ascending curve represents improvement, a straight line
represents stand still status and declining curve represents going down hill.
You should WAIT if the curve is either straight line or ascending. You repeat when the
curve is declining.
Sometimes my students in different parts of Europe and the United States doubt this
long waiting in the haste and hurry of life. I respectfully invite them to any of my
teaching clinics both the Allen Teaching Clinic and the Bengal Allen Teaching Clinic
where you can see how the methodologies detailed above are successfully
implemented in the drug dependent population.
The web site is mentioned elsewhere.
When I might change the Medicine
I will change in the following situations:
a) No improvement even after reasonable time of waiting (it is difficult to
say what is this reasonable time; as many times it’s a feeling that the
last medicine is not working but generally I will take time to make my
first prescription and will wait at least for 3 to 5 months, before I change.
In some acute situations, of course it will be different.
- 6. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
6
b) The health graph as stated above is in straight line for at least for two
consecutive follow-ups meaning there has been no change for a while
which represents stand still status or declining curve which represents
going down hill only then will I change the medicine if the symptoms
show a different picture.
c) There is severe aggravation of some symptoms and needs urgent
intervention, may be an acute or acute exacerbation of chronic
symptom.
d) Miasmatic or Aetiological block or cessation of improvement, needs an
intercurrent to remove the block.
e) The symptoms picture has changed. So to evaluate the new miasmatic
totality and totality of symptoms and prescribe accordingly.
f) Your last medicine has exhausted all that it could have done, may be
you even ascended to CM potency however, sometimes if I still feel it’s
the same medicine, according to Kent, I will repeat the series again, so
you need to change the plan of treatment either according to the
presenting totality or a complementary or related or chain of medicine
that follows well.
Some interesting notes from the Organon of
Medicine
a. Single Globule to be used : Foot Note §246 5th Ed.; §275 6th Ed.
b. Size of the globule is of Poppy-Seed : Foot Note §285 5th Ed.
c. Medicine must be dispensed in Liquid Vehicle water : §288 5th Ed.;
§272 6th Ed.; §246 6th Ed.
a Even Centesimal Scale Potencies to be dispensed in water :
Appendix. P. 263.
b Feeble action if given dry : Chronic Disease P. 159.
c Even 30th potency to be dissolved in water : §128.
d. Every Dose should be deviated from the former : §246 6th Ed., §247
6th Ed., §280 6th Ed.
e. Doctrine of Divisibility : Appendix. P. 266.
Even in dilution, the power of the medicine remains the same : §287,
§286, §285.
f. Application of Placebo : §91, §281 6th Ed..
g. Do not Repeat when the Patient is Improving: §245.
h. Against Polypharmacy : § F.N. 272.
i. Homoeopathician treats the Miasm, upon which the Malady depends
: §205.
- 7. From the desk of: Dr. Subrata K. Banerjea
© GOLD MEDALIST
DISPENSING TECHNIQUE-KEY TO SUCCESS.doc
7
j. No Food restriction in Acute Diseases : §262, 263.
k. Smallness of Dose : §277, 278, 284, 285.
l. Divided Dose :
i Diminution of strong power of medicine for sensitive patients
§285 & F.N.
ii Effect is increased but actual amount remains same §286.
iii Every portion of plussing. Smallest portion of diluting fluid
receives same quantity of medicine in proportion as all the rest
§287 and the last selected homoeopathic remedy could best
extract the morbid disorder only if applied in several different
forms § F.N. 247.
m. Do not prescribe on undefined, non-characteristic, vague symptoms:
§165
n. If two medicines are indicated: Prescribe the most indicated one, after
that’s action is over, do not automatically prescribe the second one but
re-examine the case: §169.
o. Olfaction of medicines: § F.N. 288, FN § 247.
p. How long the medicine can last: Medicinal power stay, upto 20 years
§ F.N. 288.
q. Deviation of Dose: Every potency should be deviated from former or
later §246, 247, 280.
r. No requirement of Antidote: Next selected medicine antidotes: § F.N.
249
s. Scope of Intercurrent medicine : Sulph – Hepar Sulph § F.N. 246.
t. Succussion: Every dose to be raised by sucussion §280.
u. Even after discovery of LM potency, Hahnemann did not discarded
the centesimal scale: Mentioning of 30th potency even in 6th edition
§128.
v. Do not repeat when patient is improving: §245.
w. Minutest employment of dose : §246.
x. Single globule to be administered not 6-7 globules: § F.N. 246, 275.